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Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a nationally representative sample of US adults aged >=40 years from the National Health and Nutrition Examination Survey 2001 to 2004.

ABSTRACT: Although the American Heart Association/American College of Sports Medicine's Preparticipation Questionnaire (AAPQ) is a recommended preexercise cardiovascular screening tool, it has never been systematically evaluated. The purpose of this research is to provide preliminary evidence of its effectiveness among adults aged ?40 years.Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, we calculated the sex- and age-specific proportions of adult participants in the National Health and Nutrition Examination Survey 2001 to 2004 who would receive a recommendation for physician consultation based on AAPQ referral criteria. Additionally, we compared recommended AAPQ referrals to a similar assessment using the Physical Activity Readiness Questionnaire in the study sample. AAPQ referral proportions were higher with older age. Across all age groups ?40 years, 95.5% (94.3% to 96.8%) of women and 93.5% (92.2% to 94.7%) of men in the United States would be advised to consult a physician before exercise. Prescription medication use and age were the most commonly selected items. When referral based on AAPQ was compared with that of the Physical Activity Readiness Questionnaire, the 2 screening tools produced similar results for 72.4% of respondents.These results suggest that >90% of US adults aged ?40 years would receive a recommendation for physician consultation by the AAPQ. Excessive referral may present an unnecessary barrier to exercise adoption and stress the healthcare infrastructure.

SUBMITTER: Whitfield GP

PROVIDER: S-EPMC4094111 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a nationally representative sample of US adults aged >=40 years from the National Health and Nutrition Examination Survey 2001 to 2004.

Whitfield Geoffrey P GP Pettee Gabriel Kelley K KK Rahbar Mohammad H MH Kohl Harold W HW

Circulation 20140113 10

<h4>Background</h4>Although the American Heart Association/American College of Sports Medicine's Preparticipation Questionnaire (AAPQ) is a recommended preexercise cardiovascular screening tool, it has never been systematically evaluated. The purpose of this research is to provide preliminary evidence of its effectiveness among adults aged ≥40 years.<h4>Methods and results</h4>Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, we calc ...[more]

PMID: 24421370

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Project description:PurposeFor most people, the benefits of physical activity far outweigh the risks. Research has suggested that exercise preparticipation questionnaires might refer an unwarranted number of adults for medical evaluation before exercise initiation, creating a potential barrier to adoption. The new American College of Sports Medicine (ACSM) prescreening algorithm relies on current exercise participation; history and symptoms of cardiovascular, metabolic, or renal disease; and desired exercise intensity to determine referral status. Our purpose was to compare the referral proportion of the ACSM algorithm to that of previous screening tools using a representative sample of U.S. adults.MethodsOn the basis of responses to health questionnaires from the 2001-2004 National Health and Nutrition Examination Survey, we calculated the proportion of adults 40 yr or older who would be referred for medical clearance before exercise participation based on the ACSM algorithm. Results were stratified by age and sex and compared with previous results for the ACSM/American Heart Association Preparticipation Questionnaire and the Physical Activity Readiness Questionnaire.ResultsOn the basis of the ACSM algorithm, 2.6% of adults would be referred only before beginning vigorous exercise and 54.2% of respondents would be referred before beginning any exercise. Men were more frequently referred before vigorous exercise, and women were more frequently referred before any exercise. Referral was more common with increasing age. The ACSM algorithm referred a smaller proportion of adults for preparticipation medical clearance than the previously examined questionnaires.ConclusionsAlthough additional validation is needed to determine whether the algorithm correctly identifies those at risk for cardiovascular complications, the revised ACSM algorithm referred fewer respondents than other screening tools. A lower referral proportion may mitigate an important barrier of medical clearance from exercise participation.

Project description:Background:Despite strong efficacy in randomized trials, the population effectiveness of pharmaceutical aids in long-term smoking cessation is lacking, possibly because of confounding (factors that are associated with both pharmaceutical aid use and difficulty quitting). Matching techniques in longitudinal studies can remove this confounding bias. Methods:Using the nationally representative Tobacco Use Supplement to the Current Population Survey (TUS-CPS), we assessed the effectiveness of medications to aid quitting among baseline adult smokers who attempted to quit prior to one year of follow-up in two longitudinal studies: 2002-2003 and 2010-2011. Pharmaceutical aid users and nonusers with complete data (n = 2129) were matched using propensity score models with 12 potential confounders (age, sex, race-ethnicity, education, smoking intensity, nicotine dependence, previous quit history, self-efficacy to quit, smoke-free homes, survey year, and cessation aid use). Using matched data sets, logistic regression models were fit to assess whether use of any individual pharmaceutical aid increased the proportion of patients who were abstinent for 30 days or more at follow-up. Results:Propensity score matching markedly improved balance on the potential confounders between the pharmaceutical aid use groups. Using matched samples to provide a balanced comparison, there was no evidence that use of varenicline (adjusted risk difference [aRD] = 0.01, 95% confidence interval [CI] = -0.07 to 0.11), bupropion (aRD = 0.02, 95% CI = -0.04 to 0.09), or nicotine replacement (aRD = 0.01, 95% CI = -0.03 to 0.06) increased the probability of 30 days or more smoking abstinence at one-year follow-up. Conclusions:The lack of effectiveness of pharmaceutical aids in increasing long-term cessation in population samples is not an artifact caused by confounded analyses. A possible explanation is that counseling and support interventions provided in efficacy trials are rarely delivered in the general population.

Project description:Exposures to volatile organic compounds (VOCs) are ubiquitous due to emissions from personal, commercial and industrial products, but quantitative and representative information regarding long term exposure trends is lacking. This study characterizes trends from1988 to 2004 for the 15 VOCs measured in blood in five cohorts of the National Health and Nutrition Examination Survey (NHANES), a large and representative sample of U.S. adults. Trends were evaluated at various percentiles using linear quantile regression (QR) models, which were adjusted for solvent-related occupations and cotinine levels. Most VOCs showed decreasing trends at all quantiles, e.g., median exposures declined by 2.5 (m, p-xylene) to 6.4 (tetrachloroethene) percent per year over the 15 year period. Trends varied by VOC and quantile, and were grouped into three patterns: similar decreases at all quantiles (including benzene, toluene); most rapid decreases at upper quantiles (ethylbenzene, m, p-xylene, o-xylene, styrene, chloroform, tetrachloroethene); and fastest declines at central quantiles (1,4-dichlorobenzene). These patterns reflect changes in exposure sources, e.g., upper-percentile exposures may result mostly from occupational exposure, while lower percentile exposures arise from general environmental sources. Both VOC emissions aggregated at the national level and VOC concentrations measured in ambient air also have declined substantially over the study period and are supportive of the exposure trends, although the NHANES data suggest the importance of indoor sources and personal activities on VOC exposures. While piecewise QR models suggest that exposures of several VOCs decreased little or any during the 1990's, followed by more rapid decreases from 1999 to 2004, questions are raised concerning the reliability of VOC data in several of the NHANES cohorts and its applicability as an exposure indicator, as demonstrated by the modest correlation between VOC levels in blood and personal air collected in the 1999/2000 cohort. Despite some limitations, the NHANES data provides a unique, long term and direct measurement of VOC exposures and trends.

Project description:BackgroundSocioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position (SEP) have not yet been used, and can inform strategies to narrow dietary inequities.ObjectivesWe quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among adults in Canada.MethodsAdults (≥18 y old) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n = 20,880) or 2015 (n = 13,970) were included. SEP was classified using household income (quintiles), education (5 categories), and neighborhood deprivation (quintiles). Dietary intake data from 24-h recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between the most and least disadvantaged) and absolute [Slope Index of Inequality (SII)] and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015.ResultsMean HEI-2015 scores improved from 55.3 to 59.0 (maximum: 100); however, these trends were not consistently equitable. Whereas inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [from 1.60 (95% CI: 0.09, 3.10) to 4.27 (95% CI: 2.20, 6.34)] and gradient [from SII = 2.09 (95% CI: 0.45, 3.73) to SII = 4.84 (95% CI: 2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [from SII = 8.06 (95% CI: 6.41, 9.71) to SII = 10.52 (95% CI: 8.73, 12.31)], increased in males.ConclusionsAbsolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.

Dataset Information

Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a nationally representative sample of US adults aged >=40 years from the National Health and Nutrition Examination Survey 2001 to 2004.

Publications

Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a nationally representative sample of US adults aged >=40 years from the National Health and Nutrition Examination Survey 2001 to 2004.

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